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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603802
Report Date: 05/10/2022
Date Signed: 05/11/2022 07:16:42 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2021 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20210819155153
FACILITY NAME:VAGTHOL'S RESIDENTIAL CARE CENTER #1FACILITY NUMBER:
197603802
ADMINISTRATOR:ELIZABETH ROMEROFACILITY TYPE:
735
ADDRESS:6541 FOUNTAIN AVENUETELEPHONE:
(323) 860-0250
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY:6CENSUS: 6DATE:
05/10/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Elizabeth Romero, Roy NortigaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff behavior poses as a risk to a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. The initial visit to the investigation was made by LPAs Angela Panushkina and Melissa Ruiz on 8/20/21. It was reported that Staff 1 (S1) would behave inappropriately towards Client 1 (C1). S1 was observed carressing C1 and whispering into C1's ears, making head to head contact and trying to kiss C1. It was also reported that C1 would go into S1's room privately. During the course of the investigation, interviews and record review was made. LPA met with the administrator, Elizabeth Romero, and Roy Nortiga, operations coordinator, and advised them of the allegation.

LPA conducted a plant inspection at approximately 10:25am to insure facility compliance. LPA then conducted interviews with staff, which did not reveal that S1 has behaved inappropriately with C1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20210819155153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VAGTHOL'S RESIDENTIAL CARE CENTER #1
FACILITY NUMBER: 197603802
VISIT DATE: 05/10/2022
NARRATIVE
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Both Ms. Romero and Mr. Nortiga deny S1 ever behaving inappropriately towards C1. Additional interview with another staff also did not reveal S1 ever behaving inappropriate towards C1. There were no witnesses, dates and time identified during the investigation. LPA attempted to interview the six clients, but they were all non-verbal and unable to answer the LPA's questions.

In addition to interviews, LPA reviewed S1's files and did not observe any written warnings or administrative actions.

Based on the information obtained through interviews and record review, there was insufficient evidence to corroborate the allegation of staff's behavior posing a risk to a client while in care. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael CavaTELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2